Osmani Medical College Research Articles

Post-mortem peripheral smear: A forensic diagnostic tool?

The current study of post-mortem peripheral smears was conducted in Department of Forensic Medicine, Osmania Medical College with the main objective of studying the seasonal variability of autolysis of cell lines in peripheral circulation. In the study sample of 73 subjects, peripheral smears were made in the morgue immediately after collecting blood by venepuncture. Smears were stained with Leishman stain (A Romanowsky stain) within 2 hours of preparation and light microscope was used to study changes. The changes in cell morphology, membrane integrity, cytoplasmic and nuclear changes were studied in detail using valuable information from previous studies and conclusions were arrived at. At the outset white blood cells are most suitable for TSD predictability among others in peripheral smear because they withstand extraneous variables like refrigeration and show a similar degree of autolytic changes across all seasons. The validity of all such studies on cell lines for TSD was discussed from medico legal perspective. The take home message is all the microscopic changes studied in present study provided no added advantage significantly apart from traditional gross changes like rigor mortis, algor mortis, post-mortem lividity. If properly used on regular basis, algor mortis can enhance the quality of our reporting in India with respect to TSD.

Histopathological Study of Bone Tumours in 78 Cases from a Tertiary Care Hospital, Hyderabad

Introduction: In comparison with neoplasms in other parts of body, bone tumours are relatively rare. Successful diagnosis and treatment plan of bone tumours involves team approach of pathologist, radiologist, surgeon, oncologist and radiotherapist. As histopathology diagnosis is confirmatory in bone tumours, it is very important to make treatment plan and estimation of prognosis in different bone tumours. Current study helps in understanding morphology of different bone tumours, also gives an idea about their age, sex distribution, relative frequencies and location of tumour. Aim: To review the histopathology diagnosis in bone tumours and to evaluate the distribution of different bone tumours according to age, sex and anatomical location, also to evaluate their relative frequencies. Materials and Methods: A cross-sectional study was conducted prospectively in 78 cases for a period of two years from October 2015 to September 2017, in Department of Pathology, Mehdi Nawaz Jung Institute of Oncology, Hyderabad, India and TB and Chest Hospital, Osmania Medical College, Hyderabad. Patients with suspicion of bone tumour on clinical and radiological examination, tissue specimens were referred to Department of Pathology along with essential clinical history such as the age, sex, anatomical site, radiological findings. Haematoxylin and Eosin (H&E) stain was done for all cases, followed by detailed microscopic study of H&E slides. Immunohistochemistry (IHC) marker analysis was performed in selected cases. Histopathology findings were noted. Age, sex, anatomical distribution and relative frequencies of different histological types of bone tumours were evaluated and analysed by comparing with other similar studies. Results: Out of 78 cases of suspected bone tumours, 30 cases were primary malignant bone tumours, 22 were metastatic deposits, 24 were benign tumours, two were chronic osteomyelitis. Osteosarcoma was the most common primary malignant bone tumour and giant cell tumour was most common benign bone tumour. Bone tumours were more common in males than in females most common anatomical location for primary malignant bone tumour was femur followed by tibia secondary deposits were more common in spine followed by pelvis. Conclusion: Histopathology diagnosis is confirmatory in bone tumours. Successful diagnosis of bone tumours is very important to make a treatment plan. Age, sex distribution and anatomical location of different bone tumours correlated well with other previous studies and provided an important role in the definitive diagnosis.

Incidence and Morphology of Accessory Head of Flexor Pollicis Longus in Telangana, India

Introduction: Flexor Pollicis Longus (FPL) may have accessory slips which arise from lateral or medial border of coronoid process of ulna and medial epicondyle of humerus. The accessory slip of FPL is known as Accessory Head of Flexor Pollicis Longus (AHFPL) or Gantzer’s Muscle. Aim: To study the incidence and morphology of AHFPL and the relationship of AHFPL with Median Nerve (MN) and Anterior Interosseous Nerve (AIN) in Telangana population. Materials and Methods: The present study was an observational study, conducted on 25 cadavers (21 male, 4 female) for a period of 18 months (July 2019-December 2020) in Department of Anatomy, Osmania Medical College, Hyderabad, Telangana, India. The cadavers which were used for dissection by first year MBBS students were included in the present study and the cadavers with scars, deformities and with congenital anomalies were excluded from the present study. Results: In the present study, AHFPL was found in 58% upper limbs. It was bilateral in 40%, unilateral in 18% upper limbs. The shape of AHFPL was fusiform in majority of (86.2%) upper limbs. It originated from the coronoid process of ulna in 62% and from medial epicondyle of humerus in 38% upper limbs, inserted by joining with tendon of FPL. The AHFPL was innervated by AIN in all the cases and this nerve was located posterior to AHFPL in majority of (83%) upper limbs, posterolateral in few (17%) upper limbs. The MN was related anterior to the AHFPL in most of the upper limbs. Conclusion: In the present study, AHFPL was found in 58% upper limbs. Bilateral occurrence (40%) was common than unilateral (18%). The presence of AHFPL can cause AIN syndrome, pronator teres syndrome. The knowledge of AHFPL would be useful for both physicians and surgeons to know the aetiology and management of compression neuropathy/nerve entrapment syndrome.

Kap study of hand hygiene practices among interns during COVID19 Osmania Medical College, Hyderabad

Introduction: Hand hygiene being a simple action, compliance among health care workers is < 40%. one such effort is introduction of my moments for hand hygiene. Aim & Objective: To assess the Knowledge, Attitude and Practise of hand hygiene practices among interns. Material & Methods: Study was conducted during Covid19 period (April to June 2020.) A questionnaire based on WHO's concept of Five Moments for Hand Hygiene was used to evaluate awareness of indications for hand hygiene and compliance was observed during Objective Structured Clinical Examination (OSCE) sessions. Observations & Results: 105 interns were taken for the study. 66 males (63%) and 39 females (37%) participated voluntarily. 5 internees three males and two females have not cooperated during the study. Discussion: 57.3% of positive indications for hand hygiene were correctly identified & 42.53% students were not sure about these moments which had similar findings with Mann and Wood.

Relation between Water Source and Rotaviral infection: An Observational Study

Fecal pollution of water is a major concern in river based countries as it is associated with transmition of the pathogens. Rotavirus is one of them which is the major cause of acute severe dehydrating diarrhoea in children below five years. This cross-sectional observational study was designed to determine the association of contaminated water source with Rotaviral infection among under five children admitted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the Department of Microbiology during the period from 1st January to 31st December, 2018. Total 184 under five children with acute watery diarrhoea were enrolled in this study by convenient sampling. Stool samples were obtained and assayed for rotavirus antigens by enzyme linked immunosorbent assay (ELISA). Rotaviral antigen was found positive in 86 cases. The Rotavirus infection was found highest in age group of 7 to 12 months (50.56%) and in male (59.30%) children. It was found significantly higher in patients from lower socio-economic condition (64.00%), in rural area (48.75%) and those who consumed unboiled pond water (94.44%). It was found higher among those children who were not exclusively breastfed (83.87%). Bottle feeding, lower educational level of mother and improper hand washing may serve as predisposing factors of rotavirus disease in these children. Using of contaminated drinking and household water has an important relation with Rotaviral infection. Ignorance of using boiled water can play a significant role for increased prevalence of Rotaviral diarrhoea.

Measuring the Capacity of Urine in the Post Mortem Human Urinary Bladder in a Selected Medical College

Background: Urinary bladder diseases are one of the clinical problems encountered in our daily practice.The incidence of these diseases rises with advanced age. These diseases are diagnosed clinically andconfirmed by various non invasive as well as invasive procedures and wall abnormalities are themost important indicator to diagnose such diseases. All these conditions require medical and surgicalintervention. Thereby knowledge regarding normal capacity of urinary bladder is essential to determinethe physiologic variation of this organ. Therefore, full knowledge about gross and histological features ofthe urinary bladder has hard &amp; fast implication for the investigation, diagnosis and further management.With this background the present study has been designed to evaluate the capacity of urine in postmortemhuman urinary bladder.&#x0D; Objectives: To identify the socio-demographic determinants and to determine thecapacity of urine in post mortem human urinary bladder.&#x0D; Materials and Methods: This was a descriptivetype of longitudinal study. Sample size was estimated by reviewing literatures and by expert opinion and70 human postmortem urinary bladders fulfilling the inclusion and exclusion criteria were selected in thisstudy. This study was conducted in the Department of Anatomy, Sylhet MAG Osmani Medical College,Sylhet in collaboration with the Department of Forensic Medicine, Sylhet MAG Osmani Medical College,Sylhet from 1st January 2015 to 31st December 2015.&#x0D; Results: The age of the cadaver ranged from 10 to65 years with the mean age of 32.20 (SD ± 14.38) years; 15 (21.40%) cadavers were in the age group of10-20 years, 36 (51.4%) cadavers were in the age group of 21-40 years and 19 (27.1%) cadavers werein the age group 41-65 years. There were 52 (74.3%) male and 18 (25.7%) female with a ratio of maleto female was 2.89:1. The mean capacity was 35.23 (SD ± 7.48) ml. The mean capacity of the urinarybladder was 31.20 ml (SD ± 7.28); 37.92 ml (SD ± 7.31) and 33.32 ml (SD ± 6.13) in the age group of A,B and C respectively. The difference between group A and B was highly significant (p=0.004); betweengroup B and C was significant (p=0.023); but not significant between group A and C (p=0.364). The meancapacity of urinary bladder of male and female did not differ significantly in age group A (p=0.117),group B (p=0.145) and group C (p=0.241).&#x0D; Conclusion: The gross capacity of urinary bladder was foundincreased with age up to certain limit then slightly decreased in the late age. But the capacity did not differsignificantly between male and female.&#x0D; Bangladesh Journal of Medical Science Vol.20(1) 2021 p.170-176

Autopsy Analysis of Suicidal Hanging Cases in Sylhet

Background:Suicide is one of the leading cause of unnatural death in the world. The frequency of suicidal hanging is dramatically increasing over the period of time in Bangladesh. Methods:Anautopsy reports based retrospective study carried out in the Department of Forensic Medicine of Sylhet MAG Osmani Medical College to analysis of suicidal hanging cases during the study period January 2017 to December 2018. After reviewing all postmortem reports, 230 cases of death were found due to suicidal hanging casesduring the study period. Results:The highest number of the victims 76(33.04%) were from the age group 10-19 years, followed by 61(26.52%) from 20-29 years and 126(54.78%) were female. Most of the dead bodies 38(16.52%) were brought from Gowainghat police station and majority victims 32(13.91%) locality were also in Gowainghat. The commonest autopsy findings were skin and subcutaneous tissue underneath the ligature mark found pale, white, hard, glistening 225(97.83%) and cyanosis 208(90.43%). The most common cause of deathin post mortem findings was asphyxia 213(92.61%). Conclusion: A well intended and inclusive programme is needed to reduce the frequency of suicidal hanging, which will ascertain the causative factor and helps incontrol and prevention.

Study of Serum Total Cholesterol in Cirrhosis of Liver And Its Relation With Severity of The Disease

Background: Lipid metabolism is impaired in different directions in liver cirrhosis. Dyslipidaemia seen in cirrhosis of the liver differs from that found in most of the additional reasons of secondary dyslipidaemias because lipoproteins in circulation are not only present in unusual amount but they also often have unusual composition, electrophoretic movement and forms (Nangliya et al., 2015). Materials &amp; Method: This cross-sectional study was carried out in the Department of Biochemistry, Sylhet MAG Osmani Medical College, Sylhet during the period from 1st January 2016 to 31st December 2016.Fiftypatients with cirrhosis of liver fulfilling the inclusion criteria were enrolled as group-A and 50 age-sex matched healthy adults were selected as the control group (group-B). Result: Fasting serum total cholesterol was estimated. Severity of liver Cirrhosis was categorized according to Child-Pugh scoring system and increasing severity was categorized as Child Pugh class A, B and C.Serum total cholesterol is decreased in patients with liver cirrhosis. The level of severity of liver damage significantly affects the serum total cholesterol level in cirrhosis; and may be considered as markers of severity of liver damage in cirrhosis. Conclusion: It may be concluded that hypocholesterelemia exists in patients with liver cirrhosis and screening for severity of cirrhosis by serum total cholesterol is important for intervention with appropriate therapy to reduce the severity of the disease. Key words: Liver cirrhosis,Serum total cholesterol , Child-Pugh score.

Effect of vitamin D and calcium alone or in combination in the treatment of nutritional rickets

Background: Nutritional rickets has emerged as a public health problem in Bangladesh during the past two decades, with up to 8% of children being clinically affected in some areas. Insufficiency of vitamin D and dietary calcium is thought to be the underlying cause. Vitamin D administered with or without calcium is commonly regarded as the mainstay of treatment. Calcium alone or in combination with vitamin D has also been used in the treatment of nutritional rickets. So this study was done to assess the effects of vitamin D, calcium or combination of vitamin D and calcium for the treatment of nutritional rickets in Bangladeshi children.&#x0D; Methods: This open labeled randomized comparative study was done in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital from July 1, 2010 to June 30, 2012 A total 48 rickets patient was enrolled in this study. After selection of cases patients were divided in to three groups by lottery method. Group A received single i/m dose of vitamin D 4,00,000 IU (2,00,000 IU in each buttock), Group B received calcium (750 mg per day) for 6 weeks and Group C received both calcium (750 mg per day) for 6 weeks and single i/m dose of vitamin D 4,00,000 IU (2,00,000 IU in each buttock). Response was evaluated by serum alkaline phosphatase level and using 10-point radiographic score developed by Thacher and colleagues at baseline, 6 weeks, and 12 weeks.&#x0D; Results: Mean age of the study participants was 35.83 months. Male to female ratio was 2:1. The radiographic score was significantly improved in first and second follow up (p&lt;0.001) in all groups. But there was significant difference of improvement in Group C than Group A and Group B. In Group C, the percent reduction from base to first follow up was 80.05±7.04 and 90.65±3 in second follow up which showed quick improvement in combination therapy. Serum alkaline phosphatase also significantly reduced in all three groups.&#x0D; Conclusion: Combination use of vitamin D and calcium in the treatment of nutritional rickets is more effective than prescribing either vitamin D or calcium alone.&#x0D; Birdem Med J 2021; 11(1): 39-46

Correlation Between Vitamin D3 and Fasting Blood Sugar in Type 2 Diabetes Mellitus Patients and Normal Individuals in a Bangladeshi Population

Background and Aims: Controversies prevail on association of vitamin D level and type 2 diabetes mellitus. The present study aims to compare serum 25-hydroxycholecalciferol (vitamin D3) level and fasting blood glucose in type 2 diabetes mellitus patients and healthy subjects and evaluate their association in both groups.&#x0D; Methods: This cross-sectional, observational study was done in Department of Biochemistry, Sylhet MAG Osmani Medical College, Bangladesh, between July 2015 and June 2016. The patients were selected from medicine out-patients departments (MOPD) of Sylhet MAG Osmani Medical College Hospital and Sylhet Diabetic Hospital, Bangladesh. A total of 135 study subjects were selected following convenient consecutive sampling technique. They grouped into case (Group A) i.e. 65 patients having type 2 diabetes mellitus, and control (Group B), i.e. 70 patients apparently healthy subjects (non-diabetic). Initial evaluation of the patients done by history and clinical examination was recorded in the preformed data collection sheet. Fasting blood glucose was measured by enzymatic method, while serum 25-hydroxycholecalciferol (vitamin D3) was measured by radioimmunoassay (RIA).&#x0D; Results: The mean age of 42.02±3.29 years in case (Group A); while 41.35±3.97 years in control (Group B). There were 33 male (50.76%) and 32 (49.23%) female in group A, while 35 (50%) male and 35 (50%) female in group B. No significant age difference was observed between the groups (p=0.284). Serum 25-hydroxycholecalciferol in cases (Group A) was 55.73±9.02 ng/ml and in controls (Group B) 53.77±10.86 ng/ ml (p=0.255). Fasting blood glucose was 161.98±62.47 mg/dl in cases (Group A) and 86.92±15.74 mg/dl in controls (Group B) (p&lt;0.001). No correlation was found between serum 25-hydroxycholecalciferol and fasting blood glucose in any group: in type 2 diabetic patients (case group) (r=0.010, p=0.943), in healthy controls (r=0.186, p=0.122), and all study subjects together (r=0.095, p=0.268).&#x0D; Conclusions: Our data suggest that serum 25-hydroxycholecalciferol (vitamin D3) was within optimum level in both type 2 diabetic patients and healthy individuals. However, no correlation was found between serum 25-hydroxycholecalciferol and fasting blood glucose in any group.

Bacteriological profile and sensitivity pattern of urinary tract infection patients in north east part of Bangladesh

Background: Urinary tract infection (UTI) is one of the most important causes of bacterial infections across the globe. Increasing antibiotic resistance among urinary pathogens to commonly prescribed drugs has become a therapeutic challenge. Periodic evaluation of antimicrobial activity of different antibiotics is essential as the pattern of antibiotic sensitivity may vary over periods.Methods: This cross-sectional study was undertaken in the Department of Medicine, Sylhet MAG Osmani Medical College, Sylhet from January 2019 to June 2019 among 100 adult patients admitted Medicine indoor Department confirmed as UTI on the basis of symptoms, signs and compatible investigation, urine culture either positive or negative.Results: Out of the total 100 urine samples 60 samples were positive for pathogenic organisms. Escherichia coli was isolated in 41 (68.3%) of the positive samples, followed by Klebsiella sp 13 (21.6%), Pseudomonas sp 3 (5%) Proteus sp 2 (3.3%) staph. Aureus 1 (1.66%). E coli was found to be most sensitive to nitrofurantoin (92.5%), meropenem (92.5%), amikacin (84.6%) and gentamycin (71.8%) and resistant to most commonly used drugs like cefixime (78%), cefuroxime (77.5%), ciprofloxacin (62.5%), ceftriaxone (62.5%).Conclusions: Mainly gram-negative bacilli are found to be responsible for UTI and most frequent isolated bacteria was E-coli. The most sensitive antibiotics were nitrofurantoin, meropenem, and amikacin&amp; gentamycin. Frequently usedantibiotic like cefixime, cefuroxime, cotrimoxazole, ciprofloxacin &amp; ceftriaxone were mostly resistant to E-coli.

A comparative study of bolus phenylephrine and mephentermine for treatment of hypotension during spinal anaesthesia for caesarean section

Background: Spinal anesthesia for caesarean section has several advantages over general anaesthesia like decreased risk of failed intubation, decreased risk of pulmonary aspiration of gastric contents, avoidance of the depressant effects of general anesthetics on neonate etc.Aim and Objectives: This comparative study was designed to evaluate the efficacy of Mephentermine and Phenylephrine in treating hypotension during spinal anaesthesia for cesarean section. The incidence of undesirable side effects like maternal bradycardia, nausea and vomiting also noted.Methodology: The study was conducted in the Department of OBG the Maternity Hospital, Osmania Medical College during the year August 2018- November 2019.The study includes 60 patients grouped into two groups.Results: Both Phenylephrine and Mephentermine maintained the arterial pressure effectively within 20% of baseline values. The mean value of heart rate was high in Mephentermine group compared with Phenylephrine group. The mean values of Systolic BP, Diastolic BP and MAP were higher in Phenylephrine group compared with Mephentermine group throughout the study period. Phenylephrine group required fewer number of bolus doses when compared with Mephentermine. The heart rate generally remained low throughout the study period in Phenylephrine group and the incidence of bradycardia was more in Phenylephrine group when compared with Mephentermine group. The occurrence of nausea and vomiting were similar in both groups.Conclusion: Thus, it can probably enhance organ blood flow more than mephentermine. Mephentermine increases heart rate and thus may be avoided in population where the effect may be detrimental.

Eswl for Upper Ureteric Stone With and Without JJ Stent-A Comparative Study

Objective: To find out the outcome of stenting before ESWL in the management of upper ureteric stone. Methods and materials: This prospective comparative study was conducted in the department of urology, Sylhet Osmani Medical College Hospital from January 2011 to June 2012. Sixty two patients with upper ureteric stone, aged between 18 to 60 years irrespective of sex, unilateral radio opaque upper ureteric stone of greatest diameter 2cm, patients with normal renal function and negative urine culture and were agreed to participate in the study were selected. Selected 62 patients with upper ureteric stones were divided randomly into group-A and group-B each consisting 31 patients. The patients of group-A were treated with ESWL with a JJ stent and that of group-B without JJ stent. In the patients selected for JJ placement, a 5 fr JJ stent was placed under regional anaesthesia before ESWL. Siemens Lithotripsy ESWL machine was used to impart shock waves and 3500 shockwaves was given in a session. Both the groups were compared for stone clearance, ureteric colic, steinstrasse, fever, lower urinary tract symptoms (LUTS), number of ESWL sessions. Data were processed and analyzed using software SPSS. Results: The number ESWL session in stented group [single session 10 (32.3%) and multiple sessions 21 (67.7%)] and in non-stented group [single session 9 (29.0%) and multiple sessions 22 (71.0%)] was similar in both groups (p&gt;0.05) Stones were cleared in 23 (74.2%) patients in stented group and 25 (80.6%) patients in non-stented group. Difference was not statistically significant (p&gt;0.05). Ureteric colic was significantly fewer in stented group than that of non-stented group [4 (12.9%) vs 11 (35.5%); p&lt;0.05] but surapubic pain was significantly more in stented group than that of non-stented group [13 (41.9%) vs 5 (16.1%); p&lt;0.05]; while steinstrasse [3 (9.7%) vs 5 (16.1%); p&gt;0.05] and fever [5 (16.1%) vs 2 (6.5%); p&gt;0.05] did not differ statistically significant between groups. Lower urinary tract symptoms such as urinary frequency [15 (48.4%) vs 3 (9.7%); p&lt;0.01]; urgency [17 (54.8%) vs 5 (16.1%); p&lt;0.01] and dysuria [19 (61.3%) vs 6 (19.4%); p&lt;0.01] were significantly more in stented group than that of non-stented group; but gross haematuria [21 (67.7%) vs 15 (48.4%); p&gt;0.05] were more in stented group. Conclusion: ESWL is an effective and reasonable initial therapy in the management of upper ureteric stones measuring &lt;2 cm. Pre-ESWL ureteric stenting provides no additional benefit over non-stented ESWL in their management. Moreover, stents are associated with signiûcant patient discomfort and morbidity. Bangladesh Journal of Urology, Vol. 17, No. 1, Jan 2014 p.17-22

Zinc as Adjunct Therapy in Neonatal Sepsis

Introduction:Altered zinc homeostasis is an important feature of pediatric sepsis, thus raising the possibility of zinc supplementation as a therapeutic strategy in neonatal sepsis, a major source of morbidity and mortality with few therapeutic options beyond antibiotics. Its objective was to find the role of zinc as adjunct therapy in neonatal sepsis.&#x0D; Materials and Methods: This prospective, randomized double blind placebo controlled trial was conducted in the Department of Paediatrics, Sylhet M A G Osmani Medical College, Sylhet, Bangladesh during January 2013 to December 2014. A total 288 neonates with neonatal sepsis were enrolled. Group allocation to either zinc or placebo group was done by lottery method. Each packet contained 5 mg dispersible zinc sulphate or placebo. One packet dissolved in 2.5 ml expressed breast milk was given orally or through feeding tube.&#x0D; Results: The age of the patients in zinc group and placebo group was 14.40 ± 6.49 days and 15.09 ± 7.18 days respectively. There were 49 (75.6%) male neonates and 16 (24.6%) female neonates in zinc group; while 50 (78.1%) neonates were male and 14 (21.9%) were female in placebo group. Clinical recovery was 61 (93.8%) and failure in 4 (6.2%) patients in zinc group; while clinical recovery was 59 (92.2%) and failure in 5 (7.8%) patients in placebo group. The mean clinical recovery time in zinc group was 104.20 ± 16.61 hours and that of control groups was 111.46 ± 19.43 hours.&#x0D; Conclusion: Oral zinc as adjunct therapy shortens the clinical recovery time.&#x0D; Medicine Today 2020 Vol.32(2): 112-116

Validation of Bangla generalized anxiety disorder 7 scale among general population

Anxiety disorder is the most prevalent mental disorder in Bangladesh according to the estimation of World Health Organization (WHO). Among the anxiety disorders, generalized anxiety disorder (GAD) is most common and morbid one. The generalized anxiety disorder (GAD) 7 scale is widely used, highly sensitive and reliable scale to screen GAD and other anxiety disorder for both primary and clinical settings. Because of scarcity of properly validated Bangla version of GAD 7 screening tool among the general population, this study was aimed to develop such a version. This validation study was conducted in cross-sectional design from September, 2016 to August, 2018 in the department of psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet. Adaptation was done as per Beaton et al., 2000 criteria. Total 61 patient aged e”18 years diagnosed as GAD by applying SCID CV and 65 age and sex matched healthy volunteer was taken as sample by purposively. Data was collected by administering written questioner with Bangla version of GAD 7 scale and Depression Anxiety Stress Scale (DASS) 21 Bangla. Convergent validity and discriminant validity was explored using DASS 21 Bangla scale. Data was analyzed using SPSS version 25. The result showed that, the Cronbach’s alpha value was excellent (0.90), test-retest and intra-class correlation was also good. Unidimensionality was confirmed, a cut-off point of 9 showed adequate value of sensitivity (85%) and specificity (80%) with area under curve being statistically significant (AUC=0.893-0.973). The scale showed good correlation with DASS 21 anxiety (0.637, p&lt;0.001) and stress subscale (0.576, p&lt;0.001). The metric properties of GAD 7 Bangla, its comparison with DASS 21 Bangla confirmed its cultural adaptation and validation. It would be helpful to identify the GAD in all age range of Bangla speaking people. Bang J Psychiatry 2020; 34(1):3-8

Relation between plasma lipids and relapse of idiopathic nephrotic syndrome in children

Background: Nephrotic syndrome (NS) is one of the most common renal diseases in children. It is a chronicchildhood disorder with a course of relapse and remission. Hyperlipidemia is a constant feature (95% cases)of minimal change nephrotic syndrome (MCNS) having serum cholesterol &gt;250 mg/dl. Both increased synthesisand decreased clearance of lipoproteins may contribute to the hyperlipoproteinemia which frequently complicatesthe NS. Persistent hyperlipidemia can lead to relapse of NS which is a potential risk factor for progression ofglomerular injury. Persistent hyperlipidemia and frequent relapse of NS are further responsible forcardiovascular disease and progressive glomerular damage leading to renal failure. This study was done todetermine relationship between plasma lipids and relapse of idiopathic NS in children.&#x0D; Methods: This prospective study was carried out from July 2015 to June 2017 at the Department of Paediatricsin Sylhet MAG Osmani Medical College Hospital. Patients with the diagnosis of NS fulfilling the inclusioncriteria were included in this study purposively. A total of 50 children were included into this study. Theprimary end point was to determine plasma lipids level in children having idiopathic NS at acute phase, inremission and at 6 months after completion of treatment. The secondary end point was to evaluate the relationshipbetween persistent hyperlipidemia in remission phase and relapse of NS.&#x0D; Results: Among 50 children with clinical diagnosis of NS, 35 were first episode and 15 were in relapse cases.Among the first episode NS cases serum lipids level were decreased significantly during remission but HDLwas increased, whereas in relapse cases even during remission serum lipids level were significantly higher.After six months of follow up, out of 50 patients 28 patients had persistent remission and 22 patients hadrelapsed. The relationship between plasma lipids level and the incidence of relapse showed that acute lipidfraction levels were not risk factor in relapsing NS. Only the triglyceride level during remission was a riskfactor in relapsing NS (p&lt;0.035) with OR 5.4 and 95% CI [1.06, 25.4].&#x0D; Conclusion: Persistent hypertriglyceridemia and hypercholesterolemia in remission phase is a risk factor forrelapse of idiopathic NS in children.&#x0D; Birdem Med J 2020; 10(2): 97-102

A study on evaluation of acrysof toric intraocular lens implantation to correct pre-existing corneal astigmatism in patients undergoing cataract surgery- At a tertiary care hospital

The current study evaluates the results of acrysof toric intraocular lens implantation to correct pre-existing corneal astigmatism in patients undergoing cataract surgery. This study was done on Prospective interventional at Osmania Medical College, Sarojini Devi Eye Hospital, Hyderabad. The sample of the study is included 40 eyes of 38 consecutive patients with 1.5 D or more of pre-existing astigmatism consists of cataract surgery with toric open-loop IOL implantation (Alcon, Fort Worth, TX, USA). The pre-operative markings for the position of incisions and IOL placement were being done under the slit lamp. The visual acuity, residual keratometric and refractive cylinders, and toric IOL axis were being measured. 54.71 years was the mean age of the patients. All the 40 eyes at the final check-up had post-operative unaided visual acuity of 6/12 or better. 10 patients (25 %) had an unaided visual acuity of 6/6.37 eyes (92.5%) had best corrected post-operative visual acuity of 6/9 or better. The mean pre-operative refractive astigmatism in 40 eyes was 2.34D. 22 eyes had the Refractive astigmatism of &amp;#62;2D. No eyes had refractive astigmatism of &amp;#60;1.5D. The mean axial length was 24.22mmOut of 40 eyes in which Toric IOL was implanted, the post-operative residual refractive sphere was seen in 4 eyes. Out of 40 eyes in whom Toric IOL was implanted, a post-operative residual refractive cylinder was seen in 30 eyes. 10 patients had No post-operative refractive cylinder. The mean post-operative residual refractive cylinder was 0.58D. The mean Post-operative Keratometric cylinder was 2.24D. The mean post-operative Keratometric cylinder was 2.34D. In comparison, both pre-operative and post-operative keratometric astigmatism, it was found that there was no statistically significant difference between them.The misalignment of Toric IOL was 10 degrees or less in 36 patients (94.73%) and less than 5 degrees in 22 patients (57.89%). Misalignment of &amp;#62;10 degrees (11 degrees and 13 degrees) was seen in 2 patients. The mean IOL rotation among 38 patients was 4.55 degrees (Range 0-13 degrees, SD 3.43). None of the eyes required repositioning. The results of this study show that implantation of AcrysofTor ic IOL is a good surgical method to evaluate pre-existing corneal astigmatism in cataract surgery. Acrysoftoric IOL has shown good rotational stability.

Body Mass Index and Waist Hip Ratio a Predictor of Hypertension of Adolescent Boys and Girls in a Metropolitan City in Bangladesh

Background: The associations between elevated blood pressure and overweight increasing now a days. Over the last few decades the prevalence of elevated blood pressure also increased in children due to increasing pediatric overweight because of changing dietary habits, changing pattern of life style.&#x0D; Objective: To see the body mass index and waist hip ratio a predictor of hypertension of adolescent boys and girls in a metropolitan city in Bangladesh.&#x0D; Methods and Materials: This cross-sectional– descriptive study was conducted in the department of Pediatrics, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet during the period from January 2014 to June 2014. Adolescent boys and girls in Sylhet Metropolitan City were included according to inclusion and exclusion criteria. Inclusion criteria were children aged 12-16 years in Sylhet Metropolitan City. Children aged under 12 or above 16 years and with any systemic disorder were excluded.&#x0D; Results: This study showed that 56.4% adolescents were male and 43.6% were female with ratio of male: female = 1.3:1 and their average age was 14±2 yrs. Average height of male was 154.82±49.08 cm and female was 148.42±38.09 cm. Average weight of male was 49.12±10.49 kg and that of female was 44.48±12.08 kg .Prevalence of hypertension in adolescent boys and girls of Sylhet city was 0.70% and there was a significant relationship of hypertension with the obesity. Among 7 (seven) hypertensive children, 3(42.8%) were overweight and 3(42.8%) obese (p=0.001). While waist hip ratio among those, 2(28.6%) were excellent and 5(71.4%) were average; was not significant (p=0.745) among the hypertensive adolescents.&#x0D; Conclusion: Prevalence of hypertension in apparently healthy adolescent child of Sylhet city was 0.70% and had a strong relationship with high body mass index&#x0D; J Bangladesh Coll Phys Surg 2020; 38(3): 110-115

An Observational Study to Assess Outcome of NSTEMI Patients with Raised Serum Uric Acid Level in a Tertiary Care Hospital of Bangladesh

Background: Non-ST segment elevation myocardial infarction (NSTEMI) is the commonest form of ACS and a leading global cause of premature morbidity and mortality. Evidences link serum uric acid with short and long-term major adverse outcomes (MACE) in patients with NSTEMI. Objective: To see in-hospital outcome of NSTEMI patients with raised serum uric acid level. Methodology: This cross-sectional observational study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from July, 2017 to June, 2019. Fifty NSTEMI patients with raised serum uric acid (&gt;7mg/dl in male; &gt;6mg/dl in female) level (Group A) and fifty NSTEMI patients with normal serum uric acid level (group B) admitted within 24 hours of symptom onset were consequently enrolled. In-hospital complications and mortality were recorded while continuing standard treatment for the event. Results: The mean age was 60.82 (SD 9.62) years in group A and 49.90 (SD 10.40) years in group B. The mean age of the patients of group A was significantly higher than patients of Group B (p&lt;0.001). Male preponderance was in both groups (84.0% versus 80.0%; p=0.603). Diabetes mellitus (52.0% versus 22.0%; p=0.002), hypertension (78.0% versus 52.0%; p=0.039) and dyslipidaemia (48.0% versus 12.0%; p&lt;0.001) were more frequent in group A than that of group B. But smoking status (70.0% versus 66.0%; p=0.668), family history of CAD (10.0% versus 26.0%; p=0.476) did not differ significantly. Killip class did not differ significantly between group A and group B (p=0.127). In-hospital mortality was 5 (10.0%) patients in group A and 2 (4.0%) patients in group B; did not reach the level of significance (p&gt;0.05) and complications such as post MI angina, cardiogenic shock, acute left ventricular failure, re-infarction, sinus tachycardia, sinus bradycardia, atrial flutter, atrial fibrillation, bundle branch block, ventricular tachycardia, ventricular fibrillation did not differ significantly between the two groups (p&gt;0.05). Conclusion: There is no significant difference between in-hospital outcome (mortality and complications) of NSTEMI patients with raised and normal serum uric acid level.

LEIOMYOMA OF URINARY BLADDER A RARE ENTITY: SERIES OF 3 CASES AND REVIEW OF LITERATURE

Introduction: Leiomyoma of urinary bladder is a rare entity and comprises 0.43% of all bladder tumors. Here we present our series of 3 cases and the related review of literature.Methods: 3 cases of bladder leiomyoma presented over a period of 16 months in Osmania Medical College and Hospital. Detailed history was taken, physical examination, routine blood, urine and radiological investigations were done. Patients were treated by Trensurethral Resection (TUR) of the mass and histopathological analysis with Immunohistochemistry was done for all cases.Results: All 3 cases were females with mean age of 31.6 years. All cases were endovesical type, mass near bladder neck and presented with obstructive symptoms. Two cases presented with acute retention of urine. Radiological investigations in all patients suggested a possibility of leiomyoma and all cases had reduced urinary flow rates. Histopathology confirmed the diagnosis tin all cases. No recurrence was found at one year of follow up.Conclusion: Leiomyoma of urinary bladder is a rare disorder which frequently occurs in middle aged females. Symptoms are related to its size and location, diagnosis is confirmed by histopathological analysis. Treatment is by surgery (mainly TUR). Prognosis of the disease is excellent.